Individual
DR. NICOLAS TANNER MAXIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
14845 SW MURRAY SCHOLLS DR STE 113, BEAVERTON, OR 97007-9237
(503) 590-7574
Mailing address
9010 SW OAK ST APT 116, TIGARD, OR 97223-6587
(804) 337-5620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11326
OR
1223G0001X
General Practice Dentistry
D11326
OR
Other
Enumeration date
09/11/2020
Last updated
09/09/2022
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